An anatomical reduction and maintainance of articular fracture is on of the basic principles In Orthopedic Surgery if good function is to ensue, especially in a major welght bearing joint such as hip knee ankle. In displaced articular fractures, excellent results can be achieved mainly by an open anatomical reduction and firm internal fixation. We performed an open reduction and internal flxation with plates and screws in a patient with the severely comminuted acetabular fracture, and a satisfactory result is obtained.
Acetabulum ; Ankle ; Hip ; Humans ; Joints ; Knee ; Orthopedics

BACKGROUND: The large volume of blood products are required during orthotopic liver transplantation. Any preoperative and intraoperative factors may influence the intraoperative blood products usage. METHODS: We retrospectively reviewed the demographic information, coagulation screens, thrombelastographic variables, and intraoperative blood requirements in 952 adult patients, who underwent orthotopic liver transplantation at the University of Pittsburgh Medical Center between January 1992 and December 1995. A preoperative coagulation abnormality score (CAS) was calculated by assigning one point of each abnormal result of the coagulation tests (PT, aPTT, platelet count) and thrombelastographic variables (reaction time, alpha angle, maximal amplitude, clot lysis index). Intraoperatively, blood products and pharmacologic coagulation therapy were administered based on thrombelastographic and hemodynamic data. RESULTS: Underlying liver disease, retransplantation one month after the first transplantation, poor preoperative coagulation profiles were predictive of intraoperative blood usage. Age, preoperative PT >15 sec, and CAS were not predictive of intraoperative blood usage. The severe fibrinolysis during operation occurred. More blood products were required in patients with severe fibrinolysis. CONCLUSIONS: The understanding of preoperative and intraoperative factors affecting blood product requirements can help the management of blood component therapy during liver transplantation.
Adult ; Blood Platelets ; Fibrinolysis ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Retrospective Studies ; Risk Factors*

Sarcoidosis is a disease of unknown cause characterized by the presence of noncaseating granulomatous inflammation. Because the lungs and thoracic lymph nodes are almost always involved, most patients report acute or insidious respiratory problems. Although pulmonary manifestations are usually the major clinical concern in sarcoidosis, extrapulmonary involvement is common. We report a case of sarcoidosis of the axillary lymph nodes with no evidence of lung alteration.
Humans ; Inflammation ; Lung ; Lymph Nodes* ; Sarcoidosis*

Extravaginal neonatal testicular torsion, although it is rare, is being recognized with increasing frequency. Furthermore, bilateral neonatal torsion is very uncommon. Because of the seriousness of the outcome due to the risk of future anorchia, this condition that requires prompt recognition and careful decision making. We experienced a case in which the patient had bilateral neonatal testicular torsion and the patient showed bilateral necrotized testes during operation. However, the histopathologic findings during operation showed a small intact portion only in the left testis. Right orchiectomy and left orchiopexy were performed, and the left testis was saved. We report here on this case with a review of the literature.
Decision Making ; Humans ; Infant, Newborn ; Orchiectomy ; Orchiopexy ; Spermatic Cord Torsion ; Testis*

The isolation of fetal cells from maternal circulation has the potential to allow relativelyself prenatal diagosis for all pregnant women. The present technology, however, has notreached the accuracy required for clinical diagnosis because of maternal cell contaminationSo we published a new method for enrichment of nRBC in a fetal cell isolation(1996).In this study, attempted to FISH analysis of nRBC which was isolated by our ownmethods. We evaluated the efficiency of FISH.As the results, we have successfully used FISH on enriched nRBC.We were able to identified 2 abnormal fetus which were confirmed by conventionalcytogenentic study as Down syndrome(Fig.1) and Klinefeltre syndrome(Fig.2). And thesensitivity and specificity for FISH was 86%(49/57) and 92.3%(36/39), respectively.According to our results, fetal cell analysis by FISH can be reliable used for prenatalaneuploidy diagnosis. However, the problems of enrichment of the fetal cell and FISH probeor condition should be over come before analyze.
Aneuploidy ; Diagnosis ; Erythroblasts* ; Female ; Fetus ; Fluorescence* ; Humans ; Pregnant Women ; Sensitivity and Specificity

Sarcoma of the kidney is a rare condition. Leiomyosarcoma is the most common of the kidney sarcomas. Renal leiomyosarcoma usually originates from the smooth muscle layers of the kidney, for example, the renal capsule and renal vessels. Renal pelvis neoplasms, however, are primarily transitional cell carcinomas, and renal pelvis leiomyosarcomas are extremely uncommon. Renal pelvis leiomyosarcoma has never been reported in Korea. Moreover, no more than 10 cases have been reported internationally. However, none of these were associated with kidney abnormalities. Here we describe a case of leiomyosarcoma that originated from the blind end of a bifid renal pelvis.
Female ; Humans ; Kidney Neoplasms/*pathology ; Kidney Pelvis/*pathology/radiography ; Leiomyosarcoma/*pathology ; Tomography, X-Ray Computed

PURPOSE: To evaluate the clinical usefulness of functional MR imaging (fMRI) for localization of the cerebral motor and sensory cortices and the language center in patients with complex partial seizure. MATERIALS AND METHODS: A total of 47 fMRIs were obtained in 14 patients (M:F=9:5; age 15 -50 years; 13 right handed and 1 ambidextrous) with complex partial seizure (6 temporal lobe epilepsy, 6 frontal lobe epilepsy, 1 occipitotemporal lobe epilepsy, 1 hemispheric epilepsy). Conventional MR imaging revealed no abnormality in four patients, localized cerebral atrophy in one, hippocampal sclerosis in four, and benign neoplasm in the remaining five. fMRI was performed on a 1.5 T MR scanner (GE Signa Horizon) using gradient-echo single-shot EPI. Nineteen fMRIs were obtained in eight patients who performed the language task, 16 fMRIs in ten who performed the motor task and 12 fMRIs in ten who performed the somatosensory task. The activation task consisted of three language tasks (silent picture naming, word generation from a character, categorical word generation), motor tasks (opposition of thumb and index finger for hand/dorsiflexion or extension for foot), and sensory tasks (passive tactile stimulation of hand or foot using a toothbrush). The data were analyzed using z-score (p<0.05), clustering, and cross-correlation analysis based upon homemade software, IDL 5.1. The success rate for obtaining meaningful fMRI was evaluated and activated regions were assessed on the basis of each fMRI obtained during language, motor, and omatosensory tasks. fMRI findings were compared with those of the Wada test (n = 7) for language lateralization and with invasive cortical mapping (n = 3) for the localization of eloquent cerebral cortex, especially around the central sulcus. RESULTS: The overall success rate of fMRI was 79 % (37/47); success rates of fMRI with language, sensory, and motor tasks were 89 % (17/19), 83 % (10/12), and 63% (10/16), respectively. Areas activated during language tasks (n=17) included the dorsolateral prefrontal cortex (16/17), anterior cingulate gyrus (16/17), posterior parietal area (15/17), Wernicke's area (10/17), and Broca's area (8/17). Regions activated by motor and somatosensory tasks (n=20) included the central sulcus (16/20), prefrontal cortex (15/20), posterior parietal cortex (9/20), supplementary motor area (6/20), and temporal cortex (3/20). The results of fMRI were concordant with the Wada test in six of seven subjects (86%) for language lateralization of left hemispheric dominance and with invasive cortical mapping in two of three patients (67%) for localization of the motor and sensory cortices. CONCLUSION: fMRI was successful in approximately three-quarters of patients with complex partial seizure, but at present appears to be an inadequate alternative to current invasive studies. Further clinical investigation is needed.
Atrophy ; Cerebral Cortex ; Epilepsy ; Epilepsy, Frontal Lobe ; Epilepsy, Temporal Lobe ; Fingers ; Foot ; Gyrus Cinguli ; Hand ; Humans ; Magnetic Resonance Imaging* ; Prefrontal Cortex ; Rabeprazole ; Sclerosis ; Seizures* ; Thumb

PURPOSE: To assess the metabolite ratios in gliomas to determine whether the metabolic information obtained by using by using in vivo single vexel 1H magnetic resonance spectroscopy(MRS) can be used as a marker for the grading of malignancy. MATERIALS AND METHODS: A total of 28 1H MR spectra from brain tumors in 27 patients with pathologically-proven gliomas were recorded. Seven patients had low grade gliomas (grade II astrocytoma in three, oligodendroglioma in three and mixed glioma in one), six had anaplastic gliomas (grade III astrocytoma in three and oligodendroglioma in three), and 14 had glioblastoma multiformes (grade IV), 1H MRS was performed on a 1.5T MRunit using PRESS sequence with a TR of 2000ms, a TE of 270 or 135ms and a voxel size of cm for all spectra. Relative lactate levels, NAA/Cho, NAA/Cr and Cho/Cr ratios were measured based on the peak heights of each resonance and compared among gliomas. RESULTS: Most tumors demonstrated decreased NAA, elevated Cho and lactate. Relatively high lactate and Cho levels and markedly decreased NAA level were more frequently observed in the high grade gliomas than in low grade gliomas. Marked elevation of lactate level in the solid component of the tumor was mostly observed in high grade gliomas. In a patient with gliomatosis cerebri, 1H MRS demonstrated a spectral pattern of tumor in filtration in an area that on MR images was apparently normal. However, NAA/Cr, NAA/Cho and Cho/Cr ratios did not significantly correlate, however, with the histologic grading of malignancy. Because of the partial volume effect, the heterogeneity of tumors containing solid and cystic or necrotic components within avoxel limited the interpretation of 1H MRS data for the grading of malignancy. CONCLUSION: The results suggest that in some patients in vivo single voxel 1H MRS may be useful for grading the malignancy of gliomas and evaluating the exact extent of tumors. In solid gliomas, the relative level of lactate appears to be a good markerfor the grading of malignancy.
Astrocytoma ; Brain Neoplasms ; Filtration ; Glioblastoma ; Glioma* ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Neoplasms, Neuroepithelial ; Oligodendroglioma ; Population Characteristics

Suaeda asparagoides (Miq.) has long been used as a Korean folk herbal medicine for the treatment of functional gastrointestinal disorders. However, reports on its pharmacological activity on gastrointestinal motility are scarce. The present study investigated the effects of Suaeda asparagoides water fraction of the extract (SAWF) on antral motility in vitro. Muscle strips from rat gastric antrum were set up in an organ bath in a circular orientation. SAWF (100 microg/mL) inhibited the spontaneous contraction of antral circular muscle strips. These inhibitory effects were not significantly affected by tetrodotoxin (1 microM), N omega-Nitro-L-arginine methyl ester hydrochloride (100 microM), 1H-(1,2,4)oxadiazolo(4,3-a)quinoxalin-1-one (10 microM), ryanodine (10 microM) and phentolamine (10 microM). SAWF-induced inhibition was mostly restored by cyclopiazonic acid (10 microM). Furthermore, the beta-adrenergic receptor antagonist, propranolol (10 microM), abolished SAWF-induced inhibition. These results suggest that SAWF may exert its activity on gastrointestinal smooth muscle via a-adrenergic receptors and sarcoplasmic reticulum Ca2+ ATPase.
Animals ; Baths ; Calcium-Transporting ATPases ; Carbamates ; Chenopodiaceae ; Contracts ; Gastrointestinal Diseases ; Gastrointestinal Motility ; Herbal Medicine ; Indoles ; Muscle, Smooth ; Muscles ; Organometallic Compounds ; Orientation ; Oxadiazoles ; Phentolamine ; Propranolol ; Pyloric Antrum ; Quinoxalines ; Rats ; Ryanodine ; Sarcoplasmic Reticulum ; Tetrodotoxin ; Water

PURPOSE: To determine whether 1H magnetic resonance spectroscopy (MRS) is useful in differentiating idiopathic Parkinson's disease (IPD) from progressive supranuclear palsy (PSP), based on metabolite ratios. MATERIALS AND METHODS: Using a 1.5 T MR Unit, single voxel 1H MRS using STEAM with a TR of 2000ms and a TE of 135ms was performed in seven PD and eight PSP patients. Five age-matched volunteers(mean age, 63 years) andanother five younger healthy volunteers(mean age, 30 years) were studied as normal controls. The regions of interest were the putamen and pallidum, with a size of 2 X 2 X 2cm. After measuring the spectral intensities ofeach metabolite (N-acetylaspartate=NAA, choline=Cho, creatine=Cr and lactate), relative peak height ratios ofNAA/Cr, Cho/Cr and Naa/Cho, and lactate levels among four groups were compared. ESULTS: NAA/Cho and NAA/Crratios were statistically lower in the PSP group than the IPD group (1.21 +/-0.26 versus 1.45 +/-0.20, and 1.26 +/-.23 versus 1.38 +/-0.19, respectively : p<0.05). NAA/Cho and NAA/Cr ratios were significantly lower inage-matched controls than in younger normal controls (1.39 +/-0.21 versus 1.76 +/-0.15, and 1.36 +/-0.13 versus1.79 +/-0.17, respectively : p<0.05). However, NAA/Cho and NAA/Cr ratios between age-matched controls and IPD werenot significantly different (p>0.05). Cho/Cr ratios were not different among four groups. Lactate was not detectedin any patients. CONCLUSION: NAA/Cho and NAA/Cr ratios in the corpus striatum were significantly lower in the PSP group than in the age-matched control and IPD groups. These results suggest that loss of neuron cells in thecorpus striatum is more prominent in PSP than in IPD, and that NAA/Cho and NAA/Cr ratios may help in differential diagnosis of IPD and PSP.
Corpus Striatum ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Neurons ; Parkinson Disease* ; Putamen ; Steam ; Supranuclear Palsy, Progressive*